Additional Dietary Measures May Help Children with Epilepsy

A ketogenic diet is sometimes used as a treatment in children with persistent epilepsy that has failed to respond to medical treatment. The diet can be challenging and have adverse side effects, however, so scientists are researching other dietary measures that may help reduce seizures. Researchers with Johns Hopkins Children’s Center have found that periodic fasting may help either in tandem or as an alternative to the ketogenic diet plan.

Epilepsy is a brain disorder in which a person has repeated seizures over time. About 65 million people worldwide (including about 2 million Americans) have the condition. In most cases, there may not be any known cause for the seizures. However some cases of epilepsy may be due to stroke, traumatic brain injury, infections, brain defects present at birth, a brain tumor, or metabolism disorders. Symptoms vary from person to person but could include staring spells or violent shaking and loss of alertness that can last from a few seconds to a few minutes.

As many as 20 to 40 percent of patients with epilepsy have what is known as refractory epilepsy, meaning that it is resistant to antiepileptic drugs. In these cases, children may be treated with a high-fat, low-carbohydrate diet known as the ketogenic diet which causes the body to adopt a “fasting” type state in which it produces ketones, a by-product of fat metabolism. The diet is believed to work by triggering biochemical changes that eliminate seizure-causing short circuits in the brain's signaling system. The diet must be strictly followed and requires a significant commitment to work effectively.

Because the body mimics a fasting state during the ketogenic diet, doctors at Johns Hopkins studied the effect of actual fasting to see if there may be an added benefit or if the treatment could replace the ketogenic diet as a therapy option.

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Six children, aged 2 to 7, who were already following the ketogenic diet were asked to fast on alternate days. All six of the kids had seizure disorders that had not completely resolved using the diet alone. After fasting was added to the dietary regimen, four of the six children experienced between 50 and 99 percent fewer seizures.

Based on previous studies in mice, the doctors believe that fasting works on the brain differently than the ketogenic diet, so it could potentially be used as a stand-alone therapy as well. "Our findings suggest that fasting does not merely intensify the therapeutic effects of the ketogenic diet but may actually represent an entirely new way to change the metabolism of children with epilepsy," says lead investigator Adam Hartman, MD, a pediatric neurologist.

"We don't fully understand the reasons for these marked differences,” says Eric Kossoff MD, the director of the ketogenic diet clinic at the Johns Hopkins Children’s Center, “but unraveling the mechanisms behind them will help pave the way toward new therapies for epilepsy, and is the focus of our ongoing work."

Of course, the study is very small and results are preliminary. The researchers caution that larger studies are needed to further evaluate the benefits – and potential consequences - of periodic fasting in children. Parents should discuss all epilepsy treatment with their child’s neurologist before attempting any such therapies.